Treatment:
Phase 1 therapy, including oral hygiene instructions, scaling, and root
planing was performed, and combination antibiotic therapy consisting of
500 mg amoxicillin and 500 mg metronidazole orally was administered
three times a day for a week. During the reevaluation, a significant
improvement in patients oral hygiene and bleeding index was noticed,
however, with very little improvement distal to #16. Thus, periodontal
surgical therapy was initiated after reevaluation. The patient underwent
open flap debridement around teeth #26 and 46, connective tissue
grafting around tooth #34, and anterior esthetic crown lengthening.
Tooth #16 was previously endodontically treated, and flap reflection
revealed that the vertical defect involved more than two-thirds of the
distal root with deep grade 2 furcation involvement. Therefore, distal
root amputation was performed to maintain the tooth while eliminating
the pocket and furcation area, rendering the area accessible for
maintenance using oral hygiene measures. (Figure 2)
Subsequent prosthodontic evaluation revealed that the tooth was
subjected to low occlusal forces, the access cavity was small with
minimal loss of tooth structure, precluding the need for tooth crowning.